Restoring patient wellness. Building physician practices.

Hypothyroidism

Therapeutics

Hypothyroidism may be caused by a number of factors including a reduction in hormone synthesis by the thyroid gland, thyroid gland ablation (surgery/radiation), deficient TSH, and peripheral causes. Hormone synthesis is reduced in iodine deficiency, Hashimoto’s disease, high intake of dietary goitrogens or pharmaceutical inhibitors of the thyroid, subacute thyroiditis, infiltrative thyroid disease, or congenital thyroid disease. Peripheral causes include deficient T4 to T3 conversion, excess rT3, and thyroid hormone resistance.

Thyroid Replacement Hormones

• Thyroid hormones are useful in hypothyroidism and Wilsons Temperature Syndrome. They can also decrease thyroid nodule sizes.
• However, thyroid hormone replacement can aggravate a number of conditions, so should be used cautiously. For example, adrenal cortical insufficiency (Addison’s or subclinical Addison’s syndrome), coronary artery disease (angina pectoris), cardiac arrhythmias, tachycardia, cardiomyopathy, anxiety disorders, Diabetes Mellitus Type II and Syndrome X, diabetes insipidus, osteoporosis, and thyrotoxicosis can all be exacerbated with thyroid hormone replacement.
• In addition, thyroid hormone replacement should be used cautiously with stimulant herbs or pharmaceuticals and other forms of prescription medication, such as steroid hormone replacement, anticoagulants, hypoglycemic agents, antidepressants, and cardiac medications. The high-end dosages of these thyroid hormone preparations can be very cardioactive, and if not carefully done, can potentially cause tachycardia and atrial fibrillation, even in the individual with no history of cardiac symptoms. Thus, patients taking thyroid hormone replacement must be encouraged to report adverse events and educated in the symptoms of thyrotoxicosis.

  Thyroid Hormone Replacement Options

• T3 Liothyronine sustained release: 7.5 -100 mcg b.i.d. in incremental dosages (see WTS protocol). The main advantage is that it can reset the metabolism back to normal by resetting the temperature back to 98.6° F for euthyroid and hypothyroid patients. For euthyroid patients, it is restorative, and the patient does not need any exogenous thyroid hormones after the treatment to continue feeling well. The disadvantage is that the protocol is time consuming, and some patients might have to endure unpleasant side effects for the first part of the treatment. Dr. Wilson designed this protocol.
• T3 Pure (Cytomel): 7.5-100 mcg daily. A high dose of Cytomel once a day used for euthyroid patients suffering from fatigue and Fibromyalgia is often effective in alleviating symptoms, and is easier to use. However, most people are not able to restore metabolism back to normal, nor are patients able to wean off the Cytomel without having symptoms return. Dr. Lowe designed this protocol.
• Desiccated Natural Thyroid: Prepared from domesticated animals, one grain (60 mg desiccated thyroid) contains approximately 38 mcg T4 and 9 mcg T3. One-grain increments of desiccated thyroid can be increased once a week, as long as there are no significant cardiac effects. This almost never resets the metabolism back to normal, nor are patients able to wean off the medicine without having symptoms return. However, it is easy and simple to use.
• T3 and T4 mixed: 50 mcg T3, 100 mcg T4.
• Levothyroxine: 25-200 mcg. The most popular thyroid hormone replacement, levothyroxine provides a standard dose of T4, but does not include T3 and thus adequate T3 is maintained only if T4 to t3 conversion is adequate.
• Natural Progesterone: Oral micronized progesterone 200 mg a day potentiates thyroid hormone and is indicated if a patient has excessive estrogen levels in ratio to progesterone (estrogen dominance).

  Thyroid Support
  Thyroid botanical support (Iris Versicolor, Guggule, potassium iodide) is often useful in the treatment of Wilson’s Temperature Syndrome, low body temperature, fatigue, arthritis, mild hypercholesterolemia, chronic lymphocytic thyroiditis (Hashimoto’s disease). Thyroid support is designed to provide adjunctive support for the hypothyroid patient and may be of assistance regardless of the etiology of the condition. Thyroid support can often be used as an alternative to WT3 therapy for patients with mild to moderate Wilson’s Temperature Syndrome.

• Diet and Supplements: As in any autoimmune disease, natural therapies that focus on immune system regulation are indicated. Hair mineral analysis evaluating nutritional levels can be of great value. Low levels of selenium, zinc, and iron contribute to thyroid hormone production problems. Decreasing the antigenic load by testing for and avoiding dietary antigens is indicated. Gluten sensitivity, for example, has now been associated with most autoimmune conditions, including Hashimoto’s disease. Hypothyroid patients are deficient in heat and energy and should eat warming foods. A diet high in goitrogens should be avoided.
• Digestion: Ensuring healthy digestion and absorption, including an intact and functional digestive tract lining, is critical. Supplements, such as HCL, bitter herbs, and digestive enzymes with meals, support healthy digestion. If leaky gut is identified, a medium- to long-term gut repair protocol, including the treatment of dysbiosis, is indicated. Treating dysbiosis can reduce the production of endotoxins in the gut and reduce intestinal hyperpermeability, in turn helping to modulate an over active immunity.
• Exercise: The single most important lifestyle factor one can do in improving thyroid function is exercise aerobic exercise stimulates the peripheral production of T3 by inducing 5’-deiodinase (Type I monoiodinase), an enzyme outside the thyroid gland that converts T4 into the more active T3. Aerobic exercise of a minimum three times a week should therefore be prescribed.
• Full Spectrum Light: Light stimulates T4 production through its action on the pineal gland and a reduction in melatonin production.
• Stress Reduction: Thyroid malfunction is epidemic in this century, possibly due to pesticides and chemicals ubiquitously found in our environment. Chronic emotional stress can be a causative factor as well. Thus, stress management techniques and the consumption of chemical-free whole foods should be encouraged.
• Aptogenic Herbs: Adding adaptogenic herbs is often helpful in the treatment of Hashimoto’s disease because they act as endocrine tonics that help mitigate autoimmune diseases. This is especially indicated if chronic stress or adrenal insufficiency is a factor.
• DHEA: DHEA, a major adrenal hormone, has been found to benefit a variety of autoimmune diseases in dosages of 100-200 mg/day. However, many clinicians prefer physiological doses, such as 10-50 mg/day in men and 5-15 mg/day in women. Lab work should be done to confirm physiological ranges with DHEA supplementation.
• Detoxification: he traditional use of detoxification has a place in the treatment of autoimmune disease. Therapies that support the liver to process endogenous and exogenous toxins have demonstrated benefits in managing autoimmune disease, including thyroiditis.
• WT3: WT3 treatment can also lower thyroid antibodies and ensure a better chance of controlling Hashimoto’s disease. It is not uncommon for patients to need 100 mg/day of Synthroid before treatment with WT3 and thyroid support, but only and .025 mg/day of Synthroid, if any, after treatment. WT3 therapy not only rests but also tends to clear out and reset the thyroid system (as opposed to Synthroid or Armour). WT3 therapy can often reduce the amount of thyroid medicine needed by patients who are hypothyroid. The combination of WT3 therapy and thyroid support provides a better chance of complete recovery.

  Thyroid Support Botanicals and Nutraceuticals
  This formula provides nutritional support and stimulation to the thyroid gland, improving the peripheral conversion of T4 to T3. It often decreases thyroid antibodies in Hashimoto’s thyroiditis, and, with long-term use, often increases thyroid hormone production in hypothyroid patients. In addition, it can increase the body temperature. Thyroid support formula, especially with high doses of selenomethionine, can bring thyroid antibodies down. Patients with mild to moderate cases of Wilson’s Temperature Syndrome can often recover with the use of this herbal formula or WT3 — or both.

Preferably, the components of this formula are given all together. One possible option includes 225 mg Iris versicolor, 225 mg Guggul, 200 mg Fucus, and 80 MCh Selenomethionine 1 cap t.i.d.

 

Herb/Nutrient	Action	Dose
Iris Versicolor(Blue flag)	Stimulates glandular secretion and removal of wastes through the lymphatic system	750 mg daily
Commiphora mukul(Guggul)	Naturally increases T3 levels; also effective in decreasing T3 levels in hyperthyroid patients Considered a rejuvenative and stimulant in Ayurvedic medicine	With 2.5 guggulsterones, 750 mg daily
Fucus vesiculosis(Bladderwrack or Kelp)	Provides the organ with the nutrition and substrates it requires Can increase the metabolic rate and stimulate weight loss	5 g daily
Selenomethionine	Decreases thyroid peroxidase antibodies	200 mcg daily; for faster results: 500 mcg b.i.d. week 1, then 500 mcg daily week 2, then 200 mcg daily thereafter
Tyrosine	Amino acid required for the synthesis of thyroid hormones	Up to 2 g daily, in divided doses between meals
Potassium Iodide	Element necessary for thyroid hormone metabolism	100 mcg to 50 mg a day